Archived: Number 18 Surgery

Updated 5 April 2017

Number 18 Surgery was inspected on Thursday 8 December 2016. This was a comprehensive inspection.

The practice is situated in the city of Bath The practice provides a general medical service to 6,070 patients covering an area from Lansdowne to Peasedown St John, and Saltford.  The practice has been through a year of change with over 50% of their staff retiring and new staff being employed.

The practices population is in the ninth decile for deprivation, which is on a scale of one to ten. The lower the decile the more deprived an area is compared to the national average. The practice population ethnic profile is predominantly White British. The average male life expectancy for the practice area is 80 years which is slightly higher than the national average of 79 years; female life expectancy is 85 years which is higher than the national average of 83 years.

There are 5 GP partners, two male and three female and one salaried GPs providing 3.25 whole time equivalents each week. The GP partners hold managerial and financial responsibility for running the business. The team are supported by three practice nurses, a healthcare assistant, a practice manager, an operational assistant and additional administration and reception staff.

The practice is a training practice for doctors training to become GPs.

Additional services for patients include a physiotherapist once a week, a chiropodist, midwife and health visitors.

The practice reception is open between 8am and 6pm Monday to Friday. Booked appointments are offered between 8am and 6pm. The practice offers a range of appointment types including book on the day, telephone consultations and advance appointments. Extended hours are offered on two Saturday mornings a month. These are for pre booked appointments only.

Outside of these times patients are directed to telephone the NHS 111 number for assistance.

The Number 18 surgery provided regulated activities from Number 18 Surgery, 18 Upper Oldfield Park, Bath, Avon. BA2 3JZ.

Updated 5 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Number 18 Surgery on 8 December 2016. Overall the practice is rated as good,

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs. The practice was clean, tidy and hygienic. We found that suitable arrangements were in place that ensured the cleanliness of the practice was maintained to a high standard.
• The practice was run efficiently and was well organised. There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw  areas of outstanding practice:

Following the closure of local hospital wards the practice developed an enhanced service to provide care to patients in a 65 bedded care home. The GP carries out regular timed ward rounds at the home three times a week so relatives know when they are attending. An additional ward round also takes place once a month with a pyscho geriatrician. This enhanced service has been rolled out to all other care homes in the area.

The practice has been proactive in developing safeguarding systems for a children’s safeguarding pathway created by the children’s safeguarding lead and shared through Map Of Medicine (MOM) for the whole of Bath and North East Somerset to use.

This included a RAG (Red, Amber, Green) system on their registers for child safeguarding multi disciplinary team meetings, this was being looked at by the Clinical Commissioning Group to role out across Bath and North East Somerset.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 April 2017

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The practice held virtual specialist clinics with a diabetes consultant for patients with complex diabetes needs.

• Nationally reported data from the Quality and Outcomes Framework showed that outcomes for patients were good for patients with long term conditions. For example, a patient diagnosed with high blood pressure whose last blood pressure was within normal range in the preceding 12 months was 85% which was better than the national average of 78%.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review in birthday to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• The practice proactively ran searches to check patients attended these reviews and chased up patients that did not.

Updated 5 April 2017

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• Lead staff had been attending TAFs in nurseries and met with social housing representatives to expedite moving for vulnerable families.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• The percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding five years was 78%, which was comparable to the national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 5 April 2017

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Every patient at the practice including older patients aged over 75 years had a named GP for continuity of care.

• The practice reviewed and updated patient’s information monthly to enable the ambulance service, the out of hour’s service and accident and emergency to see important information on more complex patients, this avoided inappropriate admissions to hospital.

• A lead GP carried out three regular timed, ward rounds per week at a local care home so relatives know when they are attending. They also undertook a ward round with psycho-geriatrician once a month.

• The practice had a link pharmacy and shared ways of working for reviews and information. The pharmacist reviewed those patient receiving their medicines in a dossett box to ensure appropriateness of prescribing.

• There was collaborative working with the local hospice and other providers. The practice gained consent from the patients to share their clinical record. Local hospice and community teams accessed the practices clinical system and sent updates direct to the clinical record. The local hospice and community teams MDT meetings were held at the practice to discuss patient care.

• There was a close working relationship with a dedicated health visitor for older people. The practice was involved in the Hale and Hearty project (Age UK) referring patients over 80 to the organisation for social visits.

Updated 5 April 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• The practice had a 24 hour, seven day a week automated phone system to check, make or cancel appointments

• Patients could also contact the surgery through the practices generic email address for non-urgent enquiries.

• Patients could contact the practice through twitter and facebook social media sites for non urgent queries.

• There was a teen page on the website and links to teen self help web pages.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

• The practice audited the amount of appointments required for good patient access and held appointments bookable 24/48hr in advance and telephone appointments (some into the evening) to improve access. If all appointments had been used patients are not turned away, they are added on to the end of a clinic.

• The practice provides a Saturday “commuter” clinic on two Saturdays a month for those patients who work and who need to attend routinely.

Updated 5 April 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• 86% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was higher than the national average of 84%.

• 95% of patients diagnosed with mental health issues had received a face to face review within the last 12 months. This was better than the national average of 88%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 5 April 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• The practice offered longer

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• Information was provided, if requested in ‘easy read’ version of leaflets with larger text and spacing for patients with poor sight. They also provided leaflets in braille and other languages

• A hearing loop was available in the waiting area and reception

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.

• There was a priority patients board in the back office plus a flag on the clinical system, so receptionists and other staff could get used to names and were aware of patients who may need to see the GP with more urgency,

• The practice had a shared care agreement with the local drug and alcohol service. Patients were counselled and an appropriate care plan produced to support their needs.